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The Battle for Trans Inclusive Healthcare

by Chris Paige


It's been public for a long time (since at least 2011) that Chelsea Manning (formerly Bradley) had gender identity disorder and an female alter-ego. Yet Manning's now definitive public statement about her gender, unleashed a firestorm in the media and social networks.

I am Chelsea Manning. I am a female. Given the way that I feel, and have felt since childhood, I want to begin hormone therapy as soon as possible. I hope that you will support me in this transition.

There are so many layers to this story -- and so many ways to get it wrong -- that some transgender people have simply logged off of social media for the day to avoid the worst of the ugliness.

The media mis-gendering people of transgender experience is a constant problem. Add to that the "patriotic" impulses to ridicule a convicted felon and it can be pretty nasty.

Yet, Manning's statement today was really very normal, aside from the media attention.  Statements like these are written and re-written by transgender people in transition all of the time, all the while worrying how family and co-workers and neighbors will react. 

In "Chelsea Manning and the Battle for Trans Inclusive Healthcare Without Bias," Janet Mock also brings to light just how normal Manning's situation is in terms of not having access to appropriate healthcare. Mock shares a bit of her own story,

When I was insured under my mother’s intermittent employment plan and later my own as an adult, I didn’t have access to a physician who understood my specific needs and was told that the life-changing and life-saving procedures I needed were not considered “medically necessary.” ...The only reason I am here today and am able to write is because I traveled an underground railroad of resources that gave me access to all the things that were medically necessary and vital to my survival as a young trans woman.

Mock talks about the lived realities of so many transgender people, finding work-arounds and alternative means to treatments -- sometimes even breaking the law -- in order to obtain life-sustaining services that have been disallowed for whatever reason.

This post is about our health as trans people, about how we’re told daily that who we are is not “necessary,” and about how disposable we are to this government, which fails to extend healthcare coverage to all its citizens.... this is not about rewarding prisoners. These surgeries and care are vitally necessary (whether you exist in or outside of prison walls), and it is a discussion between a patient and their doctor, not between anyone else. We need to remove society’s popular conception of morality from this discussion of a woman, a man, a person and their body. 

There are particular vulnerabilities that come with incarceration. However, working transgender adults (who otherwise have good insurance coverage) are also often refused care due to long-standing "transgender exclusions." These exclusions are used to deny not only hormones and gender confirmation surgeries, but even routine preventative care, such as prostate exams and mammograms.

These "transgender exclusions" remain even in progressive settings such as the Episcopal Church and United Church of Christ, despite denominational statements of support for transgender people.

Yet, there is broad consensus among medical and mental health professionals about the need for such services.

  • In the same year, the American Psychological Association recognized "the efficacy, benefit and medical necessity of gender transition treatments for appropriately evaluated individuals and calls upon public and private insurers to cover these medically necessary treatments;"

The medical procedures attendant to sex reassignment are not "cosmetic" or "elective" or for the mere convenience of the patient... These medical procedures are not experimental... these treatments are cost-effective rather than cost-prohibitive...

There are hopeful movements, including legislation at city, state, and federal levels. However, we have a long way to go before appropriate health care is something on which transgender people can rely.

Meanwhile, in moments of public dialogue like these, we need to speak out against bias and bigotry that disregards and even ridicules the medical needs of transgender people. 

Read Janet Mock's full article on her blog: "Chelsea Manning and the Battle for Trans Inclusive Healthcare Without Bias"


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